Epicardial linear electroporation ablation and lesion size

摘要

Background Electroporation can be used as a nonthermal method to ablate myocardial tissue. However, like with all electrical ablation methods, determination of the energy supplied into the myocardium enhances the clinically required controllability over lesion creation. Objective To investigate the relationship between the magnitude of epicardial electroporation ablation and the lesion size using an electrically isolating linear suction device. Methods In 5 pigs (60-75 kg), the pericardium was opened after medial sternotomy. A custom linear suction device with a single 35 × 6-mm electrode inside a 42-mm-long and 7-mm-wide plastic suction cup was used for electroporation ablation. Single cathodal applications of 30, 100, or 300 J were delivered randomly at 3 different epicardial left ventricular sites. Coronary angiography was performed before ablation, immediately after ablation, and after 3 months survival. Lesion size was measured histologically after euthanization. Results The mean depth of 30, 100, and 300 J lesions was 3.2 ± 0.7, 6.3 ± 1.8, and 8.0 ± 1.5 mm, respectively (P =.0003). The mean width of 30, 100, and 300 J lesions was 10.1 ± 0.8, 15.1 ± 1.5, and 17.1 ± 1.3 mm, respectively (P<.0001). Significant tissue shrinkage was observed at the higher energy levels. No luminal arterial narrowing was observed after 3 months: 2.3 ± 0.3 mm vs 2.3 ± 0.4 mm (P =.85). Conclusion The relationship between the amount of electroporation energy delivered through a linear suction device with a single linear electrode and the mean myocardial lesion size is significant in the absence of major adverse events or permanent damage to the coronary arteries.